12/30/2023 0 Comments Gas inhale mr contrast![]() Electrocardiography showed normal sinus rhythm without atrial fibrillation. Blood gas analysis results obtained three hours after leaving her house revealed the following levels: PO2, 78.3 torr PCO2, 30.1 torr pH, 7.518 base excess, 2.3 mmol/l and carboxyhemoglobin (COHb), 3.0%. Laboratory blood tests results were as follows: RBC count, 516 x 104/μl hemoglobin, 15.7 g/dl sodium, 143 mmol/L potassium, 4.0 mmol/L calcium, 1.21mmol/L blood sugar, 114 mg/dL and D-dimer, 1.4 μg/mL. On arrival at our ED, her blood pressure was 213/109 mmHg, her heart rate was 73 bpm, and her SpO2 was 100% in room air. Her symptoms worsened during transfer, and nausea and vomiting were noticed in the ambulance. The patient had no history of smoking or drug or alcohol abuse. She was medicated for hypertension and hyperlipidemia, and her blood pressure had been high over the previous few months. The patient had no initial loss of consciousness. Case PresentationĪ general physician referred an 83-year-old woman with right hemiplegia of the upper/lower limbs, hypertension, and headache to our ED. Possible mechanisms of acute and delayed CO toxicity and suggested treatments are discussed. Our report may serve as a reminder to clinicians to have a high degree of suspicion under the circumstances of CO exposure, although this is challenging for emergency physicians. Although we do not have clear evidence, we believe our high index of suspicion that our patient’s hemiplegia was caused by CO intoxication is reasonable based on rapid recovery with oxygen therapy, polycythemia, and neuroimaging. Here, we report a hemiplegia case presumably caused by acute CO intoxication with chronic CO exposure followed by immediate improvement of the neurological symptoms with oxygen therapy. However, hemiplegia associated with CO intoxication is very rare, while peripheral neuropathy of the lower extremities is a known complication of CO poisoning. This case reconfirms the importance of medical interviewing by medical practitioners, even in an emergency setting.Ĭarbon monoxide (CO) poisoning can cause various neurological complications including movement disorders and mental deterioration through hypoxic brain injury. MRI and blood tests helped to support CO as the suspected cause of her hemiplegia. Despite the hematogenous effects of CO, paralysis appeared to be more severe on her right side than on her left side. Although we do not have clear evidence, we presume that hemiplegia in our patient was caused by CO intoxication, based on rapid recovery with oxygen therapy, carboxyhemoglobin (COHb) level elevation (3.0%), polycythemia, and neuroimaging. High flow oxygen therapy was given for suspected CO intoxication and her symptoms quickly improved. The family members reported that the patient may have been exposed to CO by briquettes burned inside a closed room. There was no radiographic evidence of ischemic stroke. An 83-year-old female was transferred to our emergency unit due to hypertension with dizziness, headache, and right hemiplegia. Acute carbon monoxide (CO) poisoning remains a common cause of poison-related death and influences neurological function.
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